ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2022) 19 9.4 | DOI: 10.1530/ey.19.9.4

ESPEYB19 9. Oncology and Chronic Disease Metabolic risk in childhood cancer (2 abstracts)

9.4. Metabolic syndrome in male survivors of pediatric allogeneic hematopoietic stem cell transplantation: impact of total body irradiation, low-grade inflammation, and hypogonadism

Muhic E , Mathiesen S , Nielsen MM , Suominen A , Sørensen K , Ifversen M , Nolsöe RL , Pedersen KM , Lähteenmäki P , Nordestgaard BG , Juul A , Jahnukainen K & Müller K



klaus.mueller@regionh.dk Transplant Cell Ther. 2021 Sep;27(9): 778.e1-778.e8. PMID: 34091072.

Brief Summary: Several studies in cancer survivors have reported an increased prevalence of metabolic syndrome (MetS), which is often observed in the absence of overt obesity. Data about MetS in survivors of pediatric hematopoietic stem cell transplantation (HSCT) are scarce. This cross-sectional cohort study evaluated the prevalence and clinical presentation of MetS in 98 adult male survivors of pediatric HSCT (median follow-up 18 years, 74% received total body irradiation, TBI) and 4767 male controls from the background population.

MetS was diagnosed when three the following criteria were present: fasting plasma glucose > 5.6 mmol/L, HDL <1.03 mmol/L, fasting plasma triglyceride >1.7 mmol/L, blood pressure >130 mmHg systolic or >85 mmHg diastolic or treatment for these conditions, abdominal circumference >102 cm. The prevalence of MetS in HSCT survivors was 30% (vs 18% in age-matched controls), corresponding to the prevalence observed in 50- to 80-year-old males from the background population. Hyperglycemia was more common in HSCT survivors with MetS, in comparison with age-matched controls with MetS and 50- to 80-years old men from the reference population (76% vs 20% vs 39%). HSCT survivors with MetS had normal or low BMI more commonly than age-matched controls with MetS (41% vs 11%). MetS was associated with total body irradiation (TBI) conditioning regimen, lower testosterone levels, and higher levels of IL-6 and high sensitivity C-reactive protein. Fat distribution was evaluated by android/gynoid (AG) ratio from a whole-body dual-energy X-ray absorptiometry (DXA). Abdominal fat accumulation (increased AG fat ratio) was strongly associated with MetS, despite abdominal circumference was normal in most HSCT patients with MetS. TBI was associated with a higher abdominal adiposity, increased fasting glucose and lower testosterone levels.

This well-designed study reported an increased risk of MetS with a peculiar clinical picture, characterized by hyperglycemia and fat redistribution, with abdominal fat accumulation (despite a normal BMI) as driving factors. TBI is confirmed to be the most relevant risk factor for MetS, and there was no significant impact of primary diagnosis, age at HSCT, or graft-versus-host disease. It would have been interesting to evaluate, in addition to the abdominal circumference, the waist-to-hip and the waist-to-height ratios that represent simple parameters correlated with abdominal adiposity in cancer survivors, and can be related to DXA parameters. In fact, whole body DXA scan for body composition analysis is hardly feasible in all HSCT survivors due to its costs and radiation exposure.

Article tools

My recent searches

No recent searches.